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108 Unit 1

ABGs

TermDefinition
Methods -Percutaneous Stick -Arterial Line -Umbilical catheter -Capillary
Indications -Evaluate the Adequacy of Acid-base (pH, PaCO2, and HCO3), Ventilation (paCO2), and oxygenation (PaO2, and O2Hb) -Determine the response to therapeutic intervention -Monitor Severity and Progression of a disease process
Therapeutic Interventions -Supplemental Oxygen -Mechanical Ventilation -Diagnostic Evaluation (exercise desaturation)
Contraindications for ABG -Negative modified Allen Test -Arteriovenous shunt (dialysis patient) -Improperly functional gas analyzer -Specimen not properly anticoagulated -Visible air bubbles -Incomplete requisition (interpretation and documentation) -unlabeled specimen
Hazards of ABG Puncture -Infection of technician (needlestick) -Inappropriate medical treatment -Vessel spasm -Hematoma -Laceration of the artery -Hemorrhage -Vasovagal reaction -Loss of Limb
Equipment and Supplies -ABG syring (3-5 cc pre-heparinized) -Needle (1-1.5 inch, 22 gauge) -Needle protection device -alcohol -gauze -band-aid -gloves -rubber stopper -biohazard bag -ice container
Glass Syringe -Not gas permeable -results remain stable -if analysis cannot be performed in 30 minutes -place in ice/water slush to prevent metabolism changes -can remain stable iced for up to 2 hours
Plastic Syringe -gas permeable -most common -don't ice -results main stable for 30 minutes
Heparin prevents blood sample from clotting
Lithium Heparin -lypholized (dry) -used if running electrolyte panels -premeasured amounts for preventing dilution of samples -white dot
Sodium Heparin -usually in solution -can affect pH result -affects the electrolyte panels -used primarily with arterial lines
Adult Site Selection Sites -Radial (site of choice) -Brachial -Femoral -Popliteal -Dorsalis Pedis
Pediatric Site Selection -Radial -Brachial -Capillary
Neonates/Newborn Site Selection -Umbilical -Radial -Capillary
How long should it take for color to return in a Modified Allen's Test? 10 seconds
What do you palpate to determine? -size -direction -depth
What do you clean the site with? -alcohol -betadine
Which angle is the needle inserted at? -30-45 degree angle
How long should you apply pressure over the puncture site in normal individuals? 5 minutes
How long should you apply pressure over the puncture site in individuals on anticoagulants? 10-15 minutes
How do you mix the specimen? -inversion or rotation
Labeling Information -Date and Time -Name -FMP/SSN -Puncture sites -FIO2 or O2 liter flow -ventilator setting -Patient Temperature -Technician Name -Ordering Physician
Brachial Artery -Major artery of the upper arm -divides into radial and ulnar just below the elbow
Indication for Sticking the Brachial Artery -The radial arteries are unsuitable -Negative Allen Test
Hazards of Sticking the Brachial Artery -Deeper Vessel -Harder to stabilize -More susceptible to hematoma -Median nerve damage -No collateral circulation
Where do you palpate on for the Brachial Artery? -antecubital fossa
Where do you follow the arterial pulse on the brachial artery? -2-3 cm Proximally
What angle do you use for the Brachial artery? -45 degree angle
When must a sample be analyzed immediately regardless of syringe? -paO2 > 150 mmHg
Sampling Errors (Pre-analytic) -Air bubbles (most common) -delay in analysis -Improper Mixing (heparin unmixed) -Improper syringe -Venous Sample -Improper anticoagulant (sodium heparin) -Too little heparin (clots in machine) -Too much heparin (dilutes sample)
Gas Tensions in the Air (Bubble) -O2: 150 mmHg -CO2: essentially zero -N2 - inert
Gas Tensions in Arterial Blood -O2: normal 80-100 mmHg -CO2: normal 35-45
CO2 effect -CO2 diffuses out of the blood into the sample decreasing the PaCO2 -increases the pH of the sample
O2 effect -normally O2 in the bubble has a higher tension than the sample so O2 wil diffuse out of the bubble into the sample -increases measured PaO2
Hyperoxygenated patient 500-600 mmHg -paO2 will decrease due to diffusion
Capillary Sampling -an arterial blood gas sampling in infants -correlates wtih PacO2 and pH -does not correlate well with PaO2
Indications for Capillary Sampling -ABG analysis is needed but arterial access is not available -May only need to look at ventilation -Non-invasisve monitors are inaccurate or abnormal
Contraindications for Capillary Sampling -not performed at the certain sites -patients less than 24 years old -When there is a need for accurate analysis of oxygenation
Sites NOT to be used for Capillary Sampling -posterior curvature of the heel -fingers of neonates -previous puncture sites -swollen or edematous tissue -cyanotic poorly perfused tissue -areas of infection -peripheral arteries
Hazards of Capillary Sampling -infection -burns -hematoma -nerve damage -pain -bleeding
Equipment -gloves -pre-heparinized glass capillary tube -metal flea and magnet (for mixing sample) -lancet -gauze -warming pack/moist warm diaper -band-aid -alcohol pad
What is the heat limit for capillary sampling? -not higher than 42 degrees celsius
What is the puncture limit for capillary sampling? -not deeper than 2.0 mm
What must you not do at the site for capillary sampling? -do not squeeze the site to increase blood flow -results in excess amounts of serous fluid and venous contamination of the sample
Created by: Mdarrielle09